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THE COMPLETE GUIDE TO PERIPHERAL ARTERIAL DISEASE: SYMPTOMS, RISKS AND TREATMENTS

Periheral Arterial Disease

Peripheral Arterial Disease (PAD) is a silent, creeping condition that affects millions of people, often without them even realizing it until it’s too late. Imagine your body as a bustling city, with arteries as the highways delivering oxygen-rich blood to every corner. Now picture those highways narrowing, clogged with debris, slowing traffic to a crawl—or stopping it entirely. That’s PAD in a nutshell: a circulatory disorder where plaque buildup restricts blood flow to your limbs, most commonly your legs. Left unchecked, it can impace your ability to walk, threaten your limbs, and even cut your life short. But there’s hope—and it starts with understanding the disease, recognizing its signs, and seeking the right care from someone who truly gets it.

For over 30 years, Dr. Polyxene (Polly) Kokinos, a board-certified vascular surgeon at South Bay Vascular Center & Vein Institute (southbayvascular.com), has dedicated her career to fighting PAD in the South Bay community. She’s not just a doctor; she’s a lifeline for patients and their families, offering personalized care that big hospitals often can’t match. Unlike other local Vascular Surgeons who decided to leave large health care institutions and or academic settings because they thought more money could be made as an independent practioner, Dr Kokinos has spent her entire career serving her local community; putting her patients first and not the institution where she worked.  Her name isn't associated with the "halo" of large health care systems or universities. Her reputation is based on results: Not the names of universities or health care systems. 

This guide will walk you through everything you need to know about PAD—its symptoms, risks, and treatments—while showing why expertise, trust, and a human touch matter when your health is on the line.

What Is Peripheral Arterial Disease?

PAD is a form of atherosclerosis, where fatty deposits, cholesterol, and other substances build up inside your arteries, forming plaque that narrows or blocks them. While it can affect any artery outside the heart or brain, it most often hits the legs and feet. Think of it as a plumbing problem: when the pipes get clogged, the water can’t flow. In PAD, that “water” is blood, and without it, your muscles and tissues suffer.

According to the CDC, about 8.5 million Americans over 40 have PAD, and Dr. Kokinos has seen her share of them in her Silicon Valley practice. She’s treated over 25,000 patients in her career, from those with mild discomfort to those facing amputation. Her work at South Bay Vascular stands out because she’s built a nationally accredited surgery center designed specifically for vascular care—something you won’t find in a typical hospital. This focus lets her tackle PAD with cutting-edge tools and a deep commitment to each patient’s story.

Symptoms: Listening to Your Body’s Warnings

PAD can be sneaky. About half of those with it don’t even notice symptoms at first, which is why it’s often called a “silent killer.” But when signs do show up, they’re hard to ignore—if you know what to look for.

• Leg Pain While Walking: The classic symptom is intermittent claudication—cramping, aching, or heaviness in your calves, thighs, or buttocks that kicks in during activity and fades with rest. It’s your muscles crying out for oxygen they’re not getting.
• Pain at Rest: In severe cases, the pain doesn’t stop. It might wake you up at night, gnawing at your feet or toes. Dr. Kokinos often hears patients describe this as a relentless ache that forces them to dangle their legs off the bed for relief.
• Cold Feet or Legs: If one leg feels colder than the other, it could mean blood isn’t reaching it properly.
• Skin Changes: Look for shiny, thin, or discolored skin—sometimes bluish or pale—on your legs or feet. Hair loss on your legs can also be a clue.
• Sores That Won’t Heal: A cut or ulcer that lingers, especially on your toes or feet, is a red flag. In PAD, poor blood flow stalls healing, raising the risk of infection or gangrene.
• Black Toes: This is an emergency. Tissue death from lack of blood can turn toes black, signaling critical limb ischemia—a stage where amputation looms if untreated.

Dr. Kokinos stresses early detection. “I’ve seen too many patients wait until their toes are black before they come in,” she says. “By then, we’re racing against time. If you’re hurting when you walk or noticing these changes, don’t brush it off—get checked.”

Risks: Who’s in the Crosshairs?

PAD doesn’t strike randomly. Certain factors crank up your odds, and knowing them can push you to act sooner.

• Age: It’s most common after 50, with 12-20% of people over 60 affected.
• Smoking: This is the big one—smokers are four times more likely to develop PAD, and symptoms hit a decade earlier than in nonsmokers.
• Diabetes: High blood sugar damages arteries over time, making diabetics prime targets. Dr. Kokinos notes that anyone with diabetes for 15+ years should see a vascular surgeon, no excuses.
• High Blood Pressure and Cholesterol: These fuel plaque buildup, narrowing those vital highways.
• Family History: If heart disease or stroke runs in your family, PAD might, too.
• Race: African Americans face higher rates, partly tied to diabetes and hypertension prevalence.

Dr. Kokinos has a knack for connecting with patients on these risks. “I sit down with them and their families,” she says. “We talk about their life—smoking habits, diet, how they feel day to day. It’s not just a checklist; it’s about understanding what’s putting them at risk and how we can turn it around together.”

Treatment: Taking Back Control

The good news? PAD is treatable, especially when caught early. Treatment splits into two goals: easing symptoms and preventing disasters like heart attacks, strokes, or amputations. Here’s how it works.

• Lifestyle Changes: Step one is tackling the root causes. Quit smoking—Dr. Kokinos calls it “the single best thing you can do.” Exercise, like supervised walking programs, can boost circulation. A heart-healthy diet cuts cholesterol and plaque growth.
• Medications: Statins lower cholesterol, blood pressure meds ease artery strain, and antiplatelet drugs (like aspirin) prevent clots. For pain, cilostazol can help you walk farther.
• Procedures: When lifestyle and meds aren’t enough, Dr. Kokinos steps in with advanced options at South Bay Vascular.
  • Angioplasty uses a balloon to open blocked arteries, sometimes with a stent to keep them wide.
  • Atherectomy shaves plaque away, and
  • Bypass surgery reroutes blood around a blockage using a vein or synthetic graft. Her center’s state-of-the-art imaging and tools make these precise and effective.

Dr. Kokinos doesn’t just operate and send you home. “I give my patients my cell phone number,” she says. “If something’s wrong, I want to know right away. This isn’t a job to me—it’s a promise to be there for them and their families.”

Why Not All Vascular Surgeons Are Equal

Here’s the kicker: PAD care isn’t one-size-fits-all, and neither are vascular surgeons. Dr. Kokinos stands apart for reasons that matter to patients. She’s spent 30 years honing her craft, serving as chair of vascular surgery at Good Samaritan Hospital and leading wound care clinics in San Jose and Gilroy. Unlike many surgeons tied to big hospital systems, she’s independent, running a practice built on trust, not quotas.

At South Bay Vascular, you’re not a number on a list. “Big hospitals can feel like factories,” she explains. “Patients get rushed through, and families feel lost. I’m here for one patient, one family at a time.” Her accredited surgery center offers tech most hospitals can’t match, letting her tackle complex cases with precision. And her team—fluent in languages from Spanish to Mandarin—ensures everyone feels heard.

The Stakes Are High—And So Is the Hope

PAD isn’t just about leg pain. It’s a warning sign of heart disease and stroke risk. Untreated, it can lead to amputation—160,000 to 180,000 Americans lose limbs to PAD-related issues each year. But Dr. Kokinos offers a lifeline. “We offer hope when others say there’s none,” she says, echoing her practice’s motto. Her patients walk again, heal wounds, and reclaim their lives because she fights for them.

If you suspect PAD, don’t wait. Show your doctor your feet—take off those socks—and ask for a referral to a vascular surgeon. Better yet, call South Bay Vascular at 408-376-3626. Dr. Kokinos and her team are ready to listen, guide, and stand by you. This isn’t just about treating a disease; it’s about building trust, deepening relationships, and giving you and your family a future worth living for.